Using professional sUsing manuka honey for wound healingtandards and codes of conduct

Professional standards and codes of conduct are fundamental in setting base standards for health care professionals and are a major channelling force for those working in clinical teams. Codes of conduct are established to ensure that practitioners are working in a safe and effective manner and that patients

Honey has been used effectively for wound healing since antiquity and has become mainstream medicine in some parts of the world. Some honeys work better than others but Manuka honey has become the “gold standard” that other honeys are tested against because it has the strongest and most widespread positive medical benefits. Research #1 below describes better than I can

what the rest of the research proves. Please read it carefully.

Note; Tee Tree Oil (Melaleuca) also has powerful antibiotic effects. Manuka honey and Tea Tree Oil each have positive things in wound healing that the other doesn’t have. By combining them together the success rate may be much higher than ether alone.

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My comments are added to the research in [bold italics within brackets], all other text is from the researchers. PMID #s are provided for anyone that wants to go to PubMed and look at the original.

J Wound Ostomy Continence Nurs. 2002 Nov;29(6):295-300.Honey: a potent agent for wound healing?Lusby PE, Coombes A, Wilkinson JM.School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia.

Comment in:

J Wound Ostomy Continence Nurs. 2002 Nov;29(6):273-4.

Although honey has been used as a traditional remedy for burns and wounds, the potential for its inclusion in mainstream medical care is not well recognized. Many studies have demonstrated that honey has antibacterial activity in vitro, and a small number of clinical case studies have shown that application of honey to severely infected cutaneous wounds is capable of clearing infection from the wound and improving tissue healing.

The physicochemical properties (eg, osmotic effects and pH) of honey also aid in its antibacterial actions. Research has also indicated that honey may possess antiinflammatory activity and stimulate immune responses within a wound. The overall effect is to reduce infection and to enhance wound healing in burns, ulcers, and other cutaneous wounds.

It is also known that honeys derived from particular floral sources in Australia and New Zealand (Leptospermum spp) have enhanced antibacterial activity, and these honeys have been approved for marketing as therapeutic honeys (Medihoney and Active Manuka honey). This review outlines what is known about the medical properties of honey and indicates the potential for honey to be incorporated into the management of a large number of wound types.

PMID: 12439453

2. J Wound Care. 2008 Jun;17(6):241-4, 246-7.Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or

hydrogel: an RCT.Gethin G, Cowman S.Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin,


OBJECTIVE: To determine the qualitative bacteriological changes that occurred

during a four-week treatment period with either manuka honey or a hydrogel

dressing. This was the secondary outcome of a randomised controlled trial (RCT)

that compared the efficacy of the two treatments in desloughing venous leg ulcers.

METHOD: This was a prospective open label multicentre RCT with blinded microbiological outcome analysis. Randomisation was conducted via remote telephone. To be included, the wound bed needed to comprise at least 50% slough. [They were dealing with some nasty wounds]

Wound swabs were taken at the start of treatment and after four weeks.

RESULTS: In all, 108 patients (35 males, 73 females) aged 24-89 years (mean 68) enrolled into the study. Both groups were comparable at baseline. Eighteen patients (17%) were withdrawn due to a wound infection: six in the honey group and 12 in the hydrogel group. [Twice as many as the Manuka group]

Staphylococcus aureus was the most common isolate, being identified in 41 wounds (38%). At baseline, meticillin-resistant Staphylococcus aureus was identified in 16 wounds (10 honey versus six hydrogel). After four weeks 70% (n=7) of the manuka-honey treated wounds versus 16% (n=1) of the hydrogel treated wounds had MRSA eradicated. [Manuka honey cured 70% of the MRSA superbug infections and standard mainstream medical treatments like you will get in any care facility in the US only cured 16%]

Pseudomonas aeruginosa was reported in 14% (n=16) of all wounds at baseline. After four weeks 33% (n=2) treated with honey and 50% (n=5) treated with hydrogel had this eliminated. The number of wounds (n=11 at baseline; n=15 at week 4) with > or =3 bacteria species remained constant over the four weeks. [This looks like a place that Manuka honey and Tea Tree Oil should be combined]

CONCLUSION: Manuka honey was effective in eradicating MRSA from 70% of chronic venous ulcers. The potential to prevent infection is increased when wounds are desloughed and MRSA is eliminated. This can be beneficial to prevent cross-infection.

PMID: 18666717

3. J Clin Nurs. 2009 Feb;18(3):466-74. Epub 2008 Aug 23.

Manuka honey vs. hydrogel-a prospective, open label, multicentre, randomized Controlled trial to compare desloughing efficacy and healing outcomes in venous


Gethin G, Cowman S.

Dip Anatomy, Dip Applied Physiology, Faculty of Nursing and Midwifery, Royal

College of Surgeons in Ireland, Dublin, Ireland.

Comment in:

Evid Based Med. 2009 Oct;14(5):148.

OBJECTIVE: Comparison of desloughing efficacy after four weeks and healing

outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey

(Woundcare 18+) vs. standard hydrogel therapy (IntraSite Gel).

BACKGROUND: Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a randomised controlled trial is not available. There is a paucity of research which uses Manuka honey in venous ulcers.

DESIGN:  Prospective, multicentre, open label randomised controlled trial.

METHOD: Randomisation was via remote telephone. One hundred and eight patients with venous leg ulcers having >or=50% wound area covered in slough, not taking antibiotics or immunosuppressant therapy were recruited from vascular centres, acute and community care hospitals and leg ulcer clinics.

The efficacy of WoundCare 18+ [Manuka]  to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined. Treatment was applied weekly for four weeks and follow-up was made at week 12.

RESULTS: At week 4, mean % reduction in slough was 67% WoundCare 18+ vs. 52.9% IntraSite Gel (p = 0.054). Mean wound area covered in slough reduced to 29% and 43%, respectively (p = 0.065). Median reduction in wound size was 34% vs. 13% (p = 0.001). At 12 weeks, 44% vs. 33% healed (p = 0.037). Wounds having >50% reduction in slough had greater probability of healing at week 12 (95% confidence interval 1.12, 9.7; risk ratio 3.3; p = 0.029). Infection developed in 6 of the WoundCare 18+ group vs. 12 in the IntraSite Gel group. [Manuka works]

 CONCLUSION: The WoundCare 18+ group had increased incidence of healing, effective desloughing and a lower incidence of infection than the control. Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies.

RELEVANCE TO CLINICAL PRACTICE: This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers. Additionally, effective desloughing significantly improves healing outcomes. [Yes this is an endorsement of Manuka honey for medical use by a mainstream medical center]

PMID: 18752540

4. Int Wound J. 2008 Jun;5(2):185-94.

The impact of Manuka honey dressings on the surface pH of chronic wounds.

[The pH of wounds is commonly overlooked and there is little FDA type therapies can do to optimize this. However ph is an important part of the healing environment and something that Manuka honey is effective at helping. Please read the first and last paragraph in bold very carefully]

Gethin GT, Cowman S, Conroy RM.

Research Centre, Faculty of Nursing and Midwifery, Royal College of Surgeons,

Ireland (RCSI), Dublin, Ireland.

Chronic non healing wounds have an elevated alkaline environment. The acidic pH

of Manuka honey makes it a potential treatment for lowering wound pH, but the

duration of effect is unknown. Lowering wound pH can potentially reduce protease

activity, increase fibroblast activity and increase oxygen release consequently

aiding wound healing.

The aim of this study was to analyse the changes in surface pH and size of non healing ulcers following application of Manuka honey dressing after 2 weeks. The study was an open label, non randomised prospective study. Patients presenting consecutively with non healing chronic superficial ulcers, determined by aetiology and no reduction in wound size in previous 3 weeks.

Single pH measurements recorded using Blueline 27 glass surface electrode and R

315 pH meter set (Reagecon/Alkem, Co. Clare Ireland). Area determined using

Visitrak (Smith & Nephew, Mull, UK) digital planimetry. Apinate (Manuka honey)

(Comvita, Slough, UK) applied to wounds for 2 weeks after which wounds

re-evaluated. Eight males and nine females with 20 ulcers (3 bilateral) were

included: venous, 50% (n = 10); mixed aetiology, 35% (n = 7); arterial, 10% (n =

2) and pressure ulcer, 5% (n = 1).

Reduction in wound pH after 2 weeks was statistically significant (P < 0.001). Wounds with pH >or= 8.0 did not decrease in size and wounds with pH<or= 7.6=”” had=”” a=”” 30%=”” decrease=”” in=”” size.=”” reduction=”” 0.1=”” ph=”” unit=”” was=”” associated=”” with=”” an=”” 8.1%=”” wound=”” size=”” (p=”” <=”” 0.012).=”” the=”” use=”” of=”” manuka=”” honey=”” dressings=”” statistically=”” significant=”” and=”” elevated=”” readings=”” at=”” start=”” were=”” minimal=”” surface=”” measurements=”” may=”” contribute=”” to=”” objective=”” assessments,=”” but=”” further=”” research=”” is=”” necessary=”” determine=”” its=”” exact=”” contribution.<=”” h2=””>

PMID: 18494624

5. Br J Oral Maxillofac Surg. 2008 Jan;46(1):55-6. Epub 2006 Nov 20.

Manuka honey dressing: An effective treatment for chronic wound infections.

Visavadia BG, Honeysett J, Danford MH.

Maxillofacial Unit, Royal Surrey County Hospital, Egerton Road, Guildford Surrey,


Comment in:

Br J Oral Maxillofac Surg. 2008 Apr;46(3):258.

The battle against methicillin-resistant Staphylococcus aureus (MRSA) wound

infection is becoming more difficult as drug resistance is widespread and the

incidence of MRSA in the community increases. Manuka honey dressing has long been available as a non-antibiotic treatment in the management of chronic wound

infections. We have been using honey-impregnated dressings successfully in our

wound care clinic and on the maxillofacial ward for over a year. [This is a British medical center so they can endorse and use Manuka honey without fear of FDA legal actions]

PMID: 17113690

6. Int Wound J. 2005 Mar;2(1):10-5.

Case series of use of Manuka honey in leg ulceration.

Gethin G, Cowman S.

Royal College of Surgeons in Ireland, Dublin 2, Ireland (Republic).

Gethin G, Cowman S. Case series of use of Manuka honey in leg ulceration.

Abstract The historical and current literature reports the successful use of

honey to manage a diversity of wound aetiologies. However, only in the last 40

years is research on its mode of action and contribution to wound healing being

investigated. The challenge of managing chronic non healing wounds generated

interest in researching non standard therapies. The aims of the study were to

gain insight into the practical use of Manuka honey in wound management.

The objective was to test the feasibility of further rigorous research into the use

of honey in the management of chronic wounds. Instrumental case series were used

to examine the use of Manuka honey in eight cases of leg ulceration. To collect

the necessary data, photographs, acetate tracings, data monitoring and patient

comments and observations were used to add greater reliability and validity to

the findings.

 The wounds were dressed weekly with Manuka honey. The results obtained showed three males and five females with ulceration of different aetiologies were studied. A mean initial wound size for all wounds of 5.62 cm(2) was obtained. At the end of four-week treatment period, the mean size was 2.25 cm(2). Odour was eliminated and pain reduced. The conclusions drawn were that the use of Manuka honey was associated with a positive wound-healing outcome in these eight cases. [Most types of wounds respond well to Manuka honey] Arterial wounds showed minimal improvement only. [Remember all of these are chronic non healing wounds so minimal improvement on Manuka honey is better than previous mainstream medical treatments]

PMID: 16722850

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[Sometimes clostridial spores (botulism) end up in honey around the world. The only reported cases of this causing problems that I can find is when a small amount is given to infants under one year of age. This happens because their digestive system is ideal for botulism and the small amount of honey is too diluted to stop botulism. After one year it never seems to happen. Medically there was some worry about botulism in wounds treated with honey. Many different honeys have been used on wounds worldwide since antiquity and currently in many medical practices and I find no report of it happening so the risk seems remote. The best guess is that the honey in the concentration used on wounds keeps the pH far too acidic for botulism. (Honey is pH 3.2 – 4.5 and botulism needs above 4.6.) Also Manuka honey increases the available oxygen to the wound (See research #4 above) and botulism cannot survive in an oxygen environment. Because Manuka honey is so effective at killing the hospital superbugs that constantly infect wounds and kill people it doesn’t seem logical to withhold honey wound treatment over worry about a theoretical but apparently nonexistent problem. However this report wouldn’t be complete without this next piece of research.  There are two things of interest here first; heat ruins Manuka honeys medical value and second; commercial sterilization procedure using gamma-irradiation doesn’t.  Any medical center wanting to use Manuka honey but worried about the theoretical possibility of  botulism can put it through the gamma-irradiation process.]

7. J Pharm Pharmacol. 1996 Nov;48(11):1206-9.

The effect of gamma-irradiation on the antibacterial activity of honey. Molan PC, Allen KL.

Department of Biological Sciences, University of Waikato, Hamilton, New Zealand.

There is increasing usage of honey as a dressing on infected wounds, burns and ulcers, but there is some concern that there may be a risk of wound botulism from the clostridial spores sometimes found in honey. It is well-established that the antibacterial activity is heat-labile so would be destroyed if honey were sterilized by autoclaving, but the effect of gamma-irradiation on the antibacterial activity of honey is not known. Therefore an investigation was carried out to assess the effect on the antibacterial activity of honey when the honey was subjected to a commercial sterilization procedure using gamma-irradiation (25 kGy). Two honeys with antibacterial activity due to enzymically-generated hydrogen peroxide and three manuka honeys with non-peroxide antibacterial activity were investigated. The honeys were tested against

Staphylococcus aureus in an agar well diffusion assay. There was no significant change found in either type of antibacterial activity resulting from this form of sterilization of honey, even when the radiation was doubled (to 50 kGy). Testing of honey seeded with spores of Clostridium perfringens and C. tetani (10000 and 1000 spores g-1 of honey, respectively) showed that 25 kGy of gamma-irradiation was sufficient to achieve sterility.

PMID: 8961174

[I always try to look at all sides of a medical problem to see if there are negative reports. This is the most negative thing I found on Manuka honey. Manuka honey dressings healed 55.6% of the leg ulcers compared to standard care that healed 49.7% of the leg ulcers and they said it didn’t significantly improve healing.  My calculator says that when standard medical care heals 100 leg ulcers then Manuka honey will heal 112 leg ulcers. If I had a leg ulcer I would consider that significant.]

8. Br J Surg. 2008 Feb;95(2):175-82.

Randomized clinical trial of honey-impregnated dressings for venous leg ulcers.

Jull A, Walker N, Parag V, Molan P, Rodgers A; Honey as Adjuvant Leg Ulcer Therapy trial collaborators.

Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.

Comment in:

Evid Based Nurs. 2008 Jul;11(3):87.

BACKGROUND: The efficacy of honey as a treatment for venous ulcers has not been evaluated, despite widespread interest. This trial aimed to evaluate the safety

and effectiveness of honey as a dressing for venous ulcers.

METHODS: This community-based open-label randomized trial allocated people with a venous ulcer to calcium alginate dressings impregnated with manuka honey or usual care. All participants received compression bandaging. The primary outcome was the proportion of ulcers healed after 12 weeks. Secondary outcomes were: time to healing, change in ulcer area, incidence of infection, costs per healed ulcer, adverse events and quality of life. Analysis was by intention to treat. RESULTS: Of 368 participants, 187 were randomized to honey and 181 to usual care. At 12 weeks, 104 ulcers (55.6 per cent) in the honey-treated group and 90 (49.7 per

cent) in the usual care group had healed (absolute increase 5.9 (95 per cent confidence interval (c.i.) -4.3 to 15.7) per cent; P = 0.258). Treatment with honey was probably more expensive [Where did they buy Manuka honey that was more expensive than there standard medical supplies?] and associated with more adverse events (relative risk 1.3 (95 per cent c.i. 1.1 to 1.6); P = 0.013). There were no

significant differences between the groups for other outcomes.

CONCLUSION: Honey-impregnated dressings did not significantly improve venous ulcer healing at 12 weeks compared with usual care. [I think that the extra people that had their leg ulcers heal on Manuka honey thought it was significant]

Registration number: ISRCTN 06161544

( 2008 British Journal of Surgery Society Ltd.

Published by John Wiley & Sons, Ltd.

PMID: 18161896

9. J Appl Microbiol. 2002;93(5):857-63.

The sensitivity to honey of Gram-positive cocci of clinical significance isolated

from wounds.

Cooper RA, Molan PC, Harding KG.

Centre for Biomedical Sciences, School of Applied Sciences, University of Wales

Institute Cardiff, Llandaff Campus, Cardiff, Wales.

AIMS: To determine the sensitivity to honey of Gram-positive cocci of clinical

significance in wounds and demonstrate that inhibition is not exclusively due to

osmotic effects. [Osmotic effects have little to do with how Manuka honey works]

METHODS AND RESULTS: Eighteen strains of methicillin-resistant

Staphylococcus aureus [The deadly MRSA hospital superbug] and seven strains of vancomycin-sensitive enterococci were isolated from infected wounds and 20 strains of vancomycin-resistant enterococci [Another deadly hospital superbug] were isolated from hospital environmental surfaces. [A common source of infections] Using an agar incorporation technique to determine the minimum inhibitory concentration (MIC), their

sensitivity to two natural honeys of median levels of antibacterial activity was established and compared with an artificial honey solution.

For all of the strains tested, the MIC values against manuka and pasture honey [this honey uses hydrogen peroxide and is often neutralized by catalase produced in our body or sometimes by the bacteria] were below 10% (v/v), [It doesn’t take a high concentration of Manuka honey to have an effect] but concentrations of artificial honey at least three times higher were required to achieve equivalent inhibition in vitro.

Comparison of the MIC values of antibiotic-sensitive strains with their respective antibiotic-resistant strains demonstrated no marked differences in their susceptibilities to honey. [Manuka honey bypasses superbug resistance]

CONCLUSIONS: The inhibition of bacteria by honey is not exclusively due to

osmolarity. [Current research shows osmolarity has little to do with Manuka honeys affect on bacteria]  For the Gram-positive cocci tested, antibiotic-sensitive and

-resistant strains showed similar sensitivity to honey. [Honey works different than antibiotics so bacteria defenses are useless on honey]

SIGNIFICANCE AND IMPACT OF THE STUDY: A possible role for honey in the treatment of wounds colonized by antibiotic-resistant bacteria is indicated. [This sounds a lot like an endorsement of honey therapy for superbugs to me]

PMID: 12392533

10. J Dermatolog Treat. 2001 Mar;12(1):33-6.

Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey.

Natarajan S, Williamson D, Grey J, Harding KG, Cooper RA.

Wound Healing Research Unit, University of Wales College of Medicine, Heath Park,

Cardiff, UK.

BACKGROUND: With the ever increasing emergence of antibiotic-resistant pathogens, in particular methicillin-resistant Staphylococcus aureus (MRSA) in leg ulcers, a means of reducing the bacterial bioburden of such ulcers, other than by the use of either topical or systemic antibiotics, is urgently required. [The medical world is losing the battle with superbugs and is desperate]

METHODS: We report the case of an immunosuppressed patient [Typical of an organ transplant patient] who developed a hydroxyurea-induced leg ulcer with subclinical MRSA infection [That can easily kill an immunosuppressed patient]  which was subsequently treated with topical application of manuka honey, without cessation

of hydroxyurea [hydroxyurea is used on organ transplant patients which is probably why they didn’t stop giving it to the patient] or cyclosporin [Typical of transplant patient] .

RESULTS: MRSA was eradicated from the ulcer and rapid healing was successfully achieved. CONCLUSION: Honey is recognized to have antibacterial properties, and can also promote effective wound healing. A traditional therapy, therefore, appears to have enormous potential in solving new problems. [These Drs are in England so they can use Manuka honey to save lives without worry of the FDA]

PMID: 12171686


The information that you have just read is the final result of a process that, more often than not, takes well in excess of 200 hours. The presentations and subjects already on the website represent merely 1% of the research that I have available to the public but need to get into understandable presentations. I have a vast amount of research showing very powerful and available natural compounds from different parts of the world and how they can be extremely effective on many medical conditions.  I also have a lot of research showing serious problems created by some FDA drugs and over the counter medications. It is all written in medical terminology which varies with each medical specialty and from country to country. It makes no sense without the background and related information that is needed to put it into perspective. With enough donations I could afford to hire the help needed and speed up the process of getting this information into an understandable form and available to the public. Therefore, I am pleading for your help. Your donations will help me to help others and will also allow the website to move forward.  Your generosity is greatly appreciated.  THANK YOU!



PaulPablo777 says:

March 8, 2010 at 5:04 pm

The certain type of species of honey is effective. What if I want to use the honey in my cupboard? Not excluding the tea tree oil, how effective is the usual honey?


Tnymed says:

March 10, 2010 at 6:24 pm

Hello. In answer to your inquiry, it appears that all honey has some antibacterial and wound healing effects. But how much depends upon the types of plants the bees got it from. The honey in your cupboard may be mild or strong but it probably will help wound healing although nothing stacks up across the board like the Manuka honey. It does not make sense to refuse antibiotics and/or other standard therapies but it makes more sense to use it with standard infection fighting and wound healing treatments. We appreciate your questions and feel free to contact us anytime. TnyMED



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are protected. (Health Professions Council, 2007)

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The professional standards provided by organisations such as the Health Professions Council (HPC) and the Chartered Society of Physiotherapy (CSP) supply a framework from which physiotherapists and other health care professionals can work within and give an awareness of the minimum of what is expected of them. Knowing and understanding their own codes of conduct will in turn facilitate performance within health care teams. Thrower (2002) comments on self awareness being “the condition of being able to analyse motives for behaviour.” Therefore, if a health care professional is conscious of their own actions and the resulting consequences, they can constantly reflect to improve their practice. This could be accomplished through such models as developed by Gibbs (1988).

For health care students, codes of conduct are indispensible source of information that can be applied in unfamiliar situations as they will know what behaviour is expected of them. Codes of conduct are equally important for the more experienced professionals who may be habituated be outdated standards, which may not be adequate in the evolving area of healthcare and may prefer more traditional approaches to teamwork.

There are now more moves in health care teams to be inter rather than multi discipline teams. Multi-discipline teams tend to be “uni-disciplinary” and work “in professional isolation from each other.” (Webster, 2002) Whereas inter-discipline teams take a more collaborative approach. In current practice, there is a heightened emphasis on collaboration between different types of practitioners, in order to escape restrictions imposed by traditional team structures. Collaboration can be defined as “an interactive process requiring that the involved individuals combine their expertise, skills and resources to solve a problem or to achieve a goal.” (Stichler, 1995) For example, joint assessments of patients by nurses and physiotherapists are becoming increasingly common. They include the advantages that the patient doesn’t have to repeat information multiple times and the health care professionals will acquire a more comprehensive view of the patient as a whole. Through this fusion of knowledge and ideas “a broader spectrum of information can be pooled to design a comprehensive care plan for the client.” (Kalafatich, 1986) Thus a more comprehensive treatment plan, encompassing all aspects of the patient’s requirements, can be developed, ensuring improved care for the patient.

Professional standards are essential in determining the scope and limitations of practice. Gibbons (2003) states that “no single profession working in isolation can meet the care needs of a patient.” Therefore, professionals need to recognise when their knowledge or scope of practice is limited and another profession would be more adept to treating a patient. However, the American Nurses Association (1994) reminds clinicians that they are only “transferring the responsibility for the performance of the activity, not the professional accountability for overall care.” As health care professionals are autonomous and self regulating, it is essential that codes of conduct are established to protect the patient’s own autonomy. Autonomy can be defined as “self government” or “freedom of action.” (Compact Oxford English Dictionary, 2008) The HPC Standards of Proficiency for Physiotherapists (2007) states that clinicians must “be able to practice as an autonomous professional exercising their own professional judgement.” Conversely, this must be counterbalanced with gaining informed consent and respecting the wishes of the patient. In some cases, such as patients who lack mental capacity or are in a coma, this could prove difficult. Nevertheless, using the guidance from the codes of conduct, their own expertise and clinical reasoning and support from the health care team, the health care professional could attempt to inform and obtain consent from the patient and liaise with their carers, to provide the most appropriate treatment for the patient. Subsequently, codes of conduct play a vital role in justifying treatments and issues of accountability in the legal sphere. If professionals are abiding by the codes of conduct then their actions can be defendable.

However, there are limits as to how much codes of conduct can guide behaviour within health care teams. Merely abiding by the standards does not necessarily result in an effective team. There are barriers which need to be considered which have the potential to hinder progress: levels of communication; clashes in personalities; tribalism; effects of outside pressures; lack of stability and lack of recognition of the skills of others. For example, a team member may find themselves in a situation which forces them to bridge the gap between a patient’s right to confidentiality and their own duty to report to their team. In this sense, it seems that the codes of conduct could be conflicting. Therefore, clinical reasoning must also be utilised to decide what is best for the patient.

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If health professionals truly aim to work in a patient centred environment then boundaries between disciplines need to be dissolved and mutually respected. Subsequently, focus can be placed fully upon the patient rather than tribalism and the over-protection of roles (Donnelly, 1999.) Perhaps more importance needs placing on shared learning experiences at an undergraduate level for physiotherapy, nursing and medical students, particularly to become more acquainted with each other’s professional standards. This could help to facilitate the teams of the future, as newly qualified professionals would already be accustomed to working with other healthcare disciplines. Consequently, they may be more likely and more informed to challenge traditional rigid structures of healthcare teams. In order to fully integrate teams and to allow them to function efficiently, different codes of conduct could be combined to produce generic shared values which all disciplines could work from in a particular team. “A philosophy as a working document will facilitate teamwork as all members of the team will share common values and beliefs that have been made explicit and open.” (Jasper, 2002)

In conclusion, for professional standards and codes of conduct to be relevant in current practice they must be understood and valued by all. For them to be applicable in future practice, it is essential that health professionals reflect in and on action. (Schön, 1983) Through this, they will not only improve their own practice, but also their

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